Immunoprophylaxis (prophylactic immunization)

Immunoprophylaxis

Types of immunization Immunoglobulins and vaccines Strategies in vaccine preparation Mechanisms of action of different types of vaccines

NATURAL

Transplacental transfer of IgG Immunity after infection Immunoglobulines in milk (breast feeding) ACTIVE

IMMUNIZATION

Vaccination

Immunoglobulins and antisera (antitoxins)

ARTIFICIAL (PROPHYLACTIC)

PASSIVE

(Administration of immunoglobulins/antisera)
For prophylaxis or therapy
immediate effect temporary immunity (weeks, months)

Pasive immunization

Antibodies-Immunoglobulins (Ig)
Human immunoglobulins (from blood donors) - human serum (gama)globulin (Ig of various specificity) e.g. for immunodeficiencies... - specific immune globulins (high-titre of specific Ig) e.g. for hepatitis B, tetanus, rabies... Animal (horse) sera (antisera, antitoxins) e.g. for snake venoms, botulism, diphteria... serum disease!!!

Active immunization
(Vaccination)
Primarily for prophylaxis Requires time (weeks) for induction of immune response

Administration
- prior to exposure to pathogen (exception: rabies vaccine) - post-exposure (in combination with specific Ig)

Adjuvant
- increases immunogenicity

Long-lasting immunity
- multiple doses needed for most vaccines

Herd immunity

Vaccine types

Live (attenuated) vaccines - contain live, attenuated (weakend) infectious agents Inactivated (killed) vaccines - contain killed whole infectious agents

Subunit (antigenic) vaccines

- contain structural parts/products of infectious agents
obtained from pathogens by isolation and purification synthetic (genetic engineering)

Conjugate vaccines - contain T-independent antigen bound to T-dependent antigen Combined (polyvalent) vaccines - contain several antigens of one or more different pathogens New approches for vaccines

Live (attenuated) vaccines

Principle
Imunization with attenuated (weakened) pathogen

Examples
Several viral vaccines (against polio (oral-Sabin), mumps, measles, rubella, varicella) and some bacterial (BCG for tuberculosis)...

Advantages
Induction of both humoral (Abs) and cellular response (CTLs) Long-lasting immunity (administered in one or two doses)

Limitations
Risk in immunocompromised persons Instability (termolabile) BCG (limited efficacy)

Inactivated (killed) vaccines

Principle
Imunization with killed (inactivated) whole infective agents

Examples
Vaccines against pertussis, typhoid, polio (Salk), influenza...

Advantages
Greater stability Safety (no risk of infection)

Limitations
Low immunogenicity (only Ab induced, adjuvant required) Shorter immunity (multiple, booster administration required)

Subunit (antigenic) vaccines

Principle
Immunization with structural antigens (protein or polysaccharide) of pathogens or their products (e.g. toxoid)

Examples
Vaccine against pertussis (acellular), tetanus and diphteria (toxoid), influenza (Hemagglutinin and Neuraminidase), hepatitis B (HBsAg) and human papilloma virus (L1 protein) so-called virus-like particles (VLP), pneumococcal and meningococcal polysaccharide vaccines...

Advantages
Same as for inactivated vaccines (greater safety)

Limitations
Same as for inactivated vaccines (lower immunogenecity)

Conjugate vaccines
Principle
Immunization with capsular polysaccharide antigen of one pathogen (weak immunogen in children) conjugated to protein antigen of another pathogen (strong immunogen)

Principle of immunization with conjugated vaccines

Principle of immunization with conjugated vaccines

Principle of immunization with conjugated vaccines

Principle of immunization with conjugated vaccines

Conjugate vaccines
Principle
Immunization with capsular polysaccharide antigen of one pathogen (weak immunogen in children) conjugated to protein antigen of another pathogen (strong immunogen)

Example
Vaccines against pneumococcus, menigococcus and H. influenzae type B (capsular polysaccharide bound to diptheria toxoid )

Advantages
Same as for subunit vaccines Good immune response to capsular antigens Efficient in children in the first two years of life and asplenic persons

Limitations
Same as for subunit vaccines Relatively high cost

Combined (polyvalent) vaccines

Principle
Simultaneous immunization with several serotypes of one pathogen (either attenuated strains or antigens) or several different pathogens

Examples
Vaccines against tetanus, diphtera and pertussis (DTP), measles, mumps and rubella (MMR), polysaccharide or conjugate pneumococcal vaccines...

Advantages
The same as for appropriate single vaccines Good immune response to every component in vaccine Practical (fewer administration, fewer visits of doctor...)

Limitations
Same as for single vaccines

(Hybride vaccines with live viral vectors)

Principle
Immunization with live viral vectors (e.g. vaccinia virus) with introduced genes for immunodominant peptides of different pathogens

New approaches for vaccines

Examples
Ongoing clinical trials for several vaccines (e.g. against HIV)

Advantages
Induction of both humoral (Abs) and cellular immune response (CTLs) Possibility of polyvalent vaccine preparation

Limitations
Repeated administration not possible

New approaches for vaccines

(DNA vaccines)
Principle
Injection of bacterial plasmid with DNA containing genes for various microbial antigenes

Example
Ongoing clinical trials for several pathogens

Advantages
Induction of both humoral (Abs) and cellular immune response (CTLs) Simple handling, possibility of polyvalent vaccines preparation

Limitations
Mechanism of action and possible adverse effects not well understood

1. Example of artificial active immunization is 2. Example of artificial passive immunization is 3. Example of natural active immunization is

a. antigens from different infectious agents b. immunity to tetanus after injection of tetanus toxoid c. immunity to tetanus after injection of antitetanus immunoglobulins

4. Example of natural passive immunization is

5. Live attenuated vaccine against polio

d. whole killed microorganisms

e. induce production of mucosal IgA f. parts of infective agents or their products

6. Subunit vaccines contain 7. Inactivated vaccines contain 8. Combined vaccines contain

9. Conjugate vaccines induce production of 10. Adjuvants increase b 1.____ c 2.____ h 3.____ j 4.____ e 5.____

g. high-affinity antibodies to polysaccharides h. immunity after recovery from infectious disease

i. immunogenicity of antigens in vaccines j. transplacental transfer of IgG f 6.____ d 7.____ a 8.____ g 9.____ h 10.___